Provider Demographics
NPI:1811696412
Name:SEIN, JESSICA N
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:SEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-3101
Mailing Address - Country:US
Mailing Address - Phone:347-237-3285
Mailing Address - Fax:
Practice Address - Street 1:370 HIGH ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1227
Practice Address - Country:US
Practice Address - Phone:347-446-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORBT-21-175815OtherBACB